Autumn Lake Healthcare At Crystal Springs
Inspection Findings
F-Tag F0690
F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Based on observation, policy review, and staff interview, the facility failed ensure catheter care was provided according to professional standards of practice. This failed practice was true for one (1) of one (1) residents observed for catheter care. Resident identifier: #62. Facility census: 83.Findings included:On 10/21/25 at 10:30 AM, Licensed Practical Nurse #24 was observed providing urinary catheter care for Resident #62. The urinary catheter was not secured to the resident. When LPN #24 was asked what was
the facility policy regarding securing urinary catheters, she stated the resident had one but he pulls them off. The Director of Nursing (DON) was informed of the above findings and a request was made for the facility policy and procedure. Review of the policy and procedure titled Catheter Care with an implementation date of 04/01/25 with Centers for Medicare and Medicaid Services (CMS) referenced at F-F690 (August 2024), found no intervention to secure the urinary catheter in the policy and procedure. In addition, LPN #24 lifted the urinary drainage bag above the level of the resident's bladder allowing urine to drain back into Resident #62's bladder before attaching the drainage bag to the bed frame.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Autumn Lake Healthcare at Crystal Springs
200 Whitman Avenue Elkins, WV 26241
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
Based on observation, staff interview, and policy review, the facility failed to follow Enhanced Barrier Precautions (EBP) during urinary catheter care and wound care. This was true for one (1) of one (1) residents viewed for urinary catheter care and wound care. Resident identifier: #62. Facility census: 93.Findings included: On 10/21/25 at 10:30 AM, observed Licensed Practical Nurse (LPN) #24 perform urinary catheter care and wound care. Resident #62 was ordered EBP due to having an indwelling urinary catheter and open wound in the right groin area. LPN #24 wore gloves but did not wear a gown. When asked if the resident was on EBP she looked puzzled and then stated Yes, both residents are on EBP. LPN #24 did not attempt to put on a gown. At the end of the care, LPN #24 did not have a plastic bag in which to place soiled washcloths and towels and dropped them on the floor before being given a plastic bag.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
AUTUMN LAKE HEALTHCARE AT CRYSTAL SPRINGS in ELKINS, WV inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ELKINS, WV, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from AUTUMN LAKE HEALTHCARE AT CRYSTAL SPRINGS or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.